Provider Demographics
NPI:1275505174
Name:CABALLERO, JORGE REYES (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:REYES
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E 10TH ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5784
Mailing Address - Country:US
Mailing Address - Phone:256-238-8386
Mailing Address - Fax:256-238-1480
Practice Address - Street 1:400 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4716
Practice Address - Country:US
Practice Address - Phone:256-235-5278
Practice Address - Fax:256-238-1480
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00017489207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000086323Medicaid
AL051086323OtherBCBS PROV NO.
AL051086323OtherBCBS PROV NO.
AL000086323Medicare ID - Type Unspecified